Stent monitoring assembly and method of use thereof - Patent Application 20070122997

Abstract

To provide an assembly including a stent and a sensor positioned on and / or in the stent.SOLUTION: In an assembly according to the present invention, within certain aspects the sensors are wireless sensors, and include for example one or more fluid pressure sensors, contact sensors, position sensors, accelerometers, pulse pressure sensors, blood volume sensors, blood flow sensors, blood chemistry sensors, blood metabolic sensors, mechanical stress sensors and / or temperature sensors. Within certain aspects these stents may be utilized to assist in stent placement, monitor stent function, identify complications of stent treatment, monitor physiologic parameters and / or medically image a body passageway, e.g., a vascular lumen.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] The present invention relates generally to the field of vascular and non-vascular stents, and more particularly to stents used in monitoring various medical conditions including, for example, the occurrence of restenosis, stent occlusion, and / or other diseases.

[0002] Description of Related Applications This application claims the benefit of U.S. Provisional Patent Application No. 61 / 787,861, filed March 15, 2013, under 35 U.S.C. § 119(e), which is incorporated by reference in its entirety. [Background technology]

[0003] A stent is generally a generally cylindrical, flexible, hollow, scaffold-like medical device that can be inserted into a body lumen to physically hold open structures and / or passageways (typically tubular organ structures, such as blood vessels, the digestive tract, the urinary tract, the respiratory tract, or the male and female reproductive tract) that have become closed or partially occluded, thereby reducing or preventing the passage of substances. Stents are usually placed in the affected organ in a compressed form by insertion percutaneously (e.g., vascular stents) or through a natural orifice (e.g., the mouth, nose, anus), and then expanded into place (often by inflating a balloon or by use of a "self-expanding" stent), thereby opening the organ lumen back to its original size and shape. Stents can be used to treat and / or prevent a wide variety of diseases and / or conditions resulting from luminal narrowing or obstruction, whether due to trauma or external compression of the vessel wall (benign or malignant tumors, abscesses, cysts), due to disease processes occurring within the vessel wall (e.g., cancer, atherosclerosis, inflammation, scarring, or stenosis) and / or due to disease processes occurring on the surface (or within) the vessel wall (thrombosis, atherosclerosis, restenosis, tumor growth, inflammation and scarring, gallstones, urinary "stones," mucosal impaction, etc.). Stents are used in a wide variety of tubular body passages to maintain the normal passage of intraluminal materials (blood, digestive contents, digestive enzymes and bile, air, urine, reproductive materials), including, for example, vascular structures (e.g., coronary arteries, carotid arteries, cerebral arteries, vertebral arteries, iliac arteries, femoral arteries, popliteal arteries, tibial arteries, mesenteric arteries, pulmonary arteries, and other branches of these arteries; large veins, e.g., superior vena cava, inferior vena cava, veins of the neck, upper and lower extremities); digestive structures; (e.g., esophagus, duodenum, small intestine, colon, biliary tract, and pancreatic duct), pulmonary structures (e.g., to keep the trachea, bronchi, bronchioles, or alveoli open), urinary system structures (collecting system, ureters, urethra), female and male reproductive system structures (e.g., to keep the fallopian tubes, prostatic urethra open), sinus structures in the head and skull (maxillary sinuses, frontal sinuses, lacrimal ducts), and inner ear structures (tympanostomy tubes).

[0004] Typically, stents are constructed of metallic components (such as stainless steel, titanium, platinum, nitinol, cobalt chromium, etc.) and / or polymeric components (degradable and non-degradable polymers), and these stents are often either monolithic or multi-component (e.g., bifurcated stent systems). Stents may be non-degradable, partially degradable, or fully degradable. Additionally, stents may be coated with one or more different compositions, including both polymers and drugs (see, e.g., U.S. Pat. Nos. 8,003,157; ​​7,294,145; 8,277,867; 8,277,833; and U.S. Patent Application Publication Nos. 2005 / 0181011 and 5,716,981). Representative examples of stents include those disclosed in U.S. Patent Nos. 6,852,153, 7,942,923, 7,753,947, 7,879,082, and 8,287,588.

[0005] One of the major uses of stents is the treatment of coronary vascular disease, peripheral vascular disease, and cerebrovascular disease. Briefly, coronary vascular disease typically begins with the development of stenosis or blockage in the coronary vasculature (right coronary artery, left coronary artery, left anterior descending artery, left circumflex artery, coronary sinus and their branches), peripheral vascular disease most often results from stenosis or blockage in the arteries of the legs (common iliac artery, iliac artery, femoral artery, superficial femoral artery, popliteal artery and their branches), renal arteries (renal arteries), or arteries of the upper limbs, and cerebrovascular disease involves the arteries of the head and neck (common carotid artery, internal carotid artery and their branches, cerebral arteries, vertebral arteries), although any blood vessel in the body may also be affected. Partial occlusion of one or more coronary arteries is often due to the development and progression of atherosclerotic plaque formation, resulting in angina pectoris (chest pain and shortness of breath on exertion), while complete occlusion of a coronary artery is usually due to plaque rupture and thrombus formation, resulting in acute coronary syndrome (ACS) and / or myocardial infarction (heart attack). In peripheral arterial disease, partial occlusion of blood vessels in the legs results in claudication (pain or "heaviness" with walking or exertion), complete vascular occlusion results in acute ischemia and gangrene, while in cerebrovascular disease, narrowing of blood vessels supplying the brain results in syncope (fainting), dizziness and transient numbness (paralysis), weakness and speech abnormalities (to name just a few symptoms), while complete occlusion results in a cerebrovascular accident (CVA or "stroke") in the brain and permanent neurological deficits. To address problems caused by either stenosis or occlusion, a stent can be delivered to the site of the occlusion, typically mounted on a delivery device designed to deliver and deploy the stent, and then open across the lesion, thereby restoring downstream blood flow.A typical method for deploying a stent is as follows: a catheter is inserted into the bloodstream (often via the femoral artery in the groin) and advanced through the bloodstream until it reaches the site of a stenosis or blockage; the catheter is then advanced across the lesion; the lesion is then opened using either a balloon alone (angioplasty) or a stent crimped onto an expandable balloon catheter (direct stenting); the artery is then opened and the expanded stent is then left in place to hold the lumen of the formerly occluded vessel open. In "self-expanding" stents, no balloon is required to open the stent; instead, the stent expands in place from the delivery catheter after deployment. Examples of such procedures are described in U.S. Pat. No. 5,749,824 and WO 98 / 36709. Non-vascular stent placement follows much the same procedure, but the stent is accessed through a natural orifice (mouth, nose, anus) and is usually placed in place under direct vision (endoscopy), after which it is expanded and deployed.

[0006] Although many technological advances have been made in recent years with respect to stent construction, drug loading and delivery, there are still many shortcomings that have not yet been addressed.

[0007] Accurate placement, deployment, and sufficient expansion of stents continues to be a challenge, particularly in the vascular system, where indirect visualization techniques, such as angiography, are primarily used for stent placement; angiography (in which a radiopaque dye is passed through the bloodstream) shows only the vascular luminal anatomy and does not provide information about abnormalities in the vessel wall (which are often the critically diseased segment being treated). Sufficient and complete deployment (sufficient opening) of a stent is often difficult to confirm using angiography alone. Long lesions and branched lesions (disease occurring at bifurcations in an artery) often require the use of multiple stents, overlapping stents, or bifurcated stents, and accurate placement and accurate determination of the amount of overlap between adjacent stents (the greater the overlap between consecutive or connected stents, the greater the risk of eventual failure) are also difficult to confirm. A stent with sensors that can provide the physician with real-time information regarding vessel wall abnormalities, balloon and vessel wall pressure, stent location within the vessel wall, stent fullness and deployment, patency / lumen size within the stent, contact and overlap between adjacent / connected stents, blood flow through the device, and confirmation of placement after deployment would be extremely beneficial to the physician and would significantly reduce long-term complication rates.

[0008] After deployment, monitoring the occurrence of potential complications (kinking, stent fracture, restenosis, thrombosis, malapposition) can aid in better post-procedural patient management and alert both the patient and physician to the occurrence of potentially serious side effects. Additionally, monitoring the surface characteristics of the stent to determine the healing status of the device within the artery can help determine when and why a patient can be weaned off antiplatelet (or anticoagulant) therapy. Continuous monitoring of physiological parameters, such as pulse rate, pulse pressure, blood pressure, and blood flow, can provide useful information regarding overall systemic and regional cardiovascular function. Additionally, in the case of biodegradable and bioerodible stents, sensors implanted on various surfaces (luminal and paraluminal surfaces) within a polymeric (typically polymeric) stent and at various depths within the polymeric (typically polymeric) stent can provide useful information regarding the rate of stent dissolution and eventual complete bioabsorption. In drug-eluting stents, sensors can be used to monitor the release of therapeutic agents from the device.

[0009] Postoperative in-hospital monitoring of stented patients is performed by personal visits by hospital staff and medical teams, with medical monitoring (vital signs, telemetry, etc.) and diagnostic imaging and blood studies as needed. Once the patient is discharged from the hospital, stent performance and patient prognosis are monitored during regular physician office visits, where a complete medical history, physical examination, and complementary imaging and diagnostic studies are used to monitor the patient's progress and identify any potential complications. During such visits, the physician typically evaluates physical signs and symptoms, performs indicated studies (ECG, echocardiography, angiography), and questions the patient to determine activity level, daily function, pain, and rehabilitation progress. [Prior art documents] [Patent documents]

[0010] [Patent Document 1] U.S. Patent No. 8,003,157 [Patent Document 2] U.S. Patent No. 7,294,145 [Patent Document 3] U.S. Patent No. 8,277,867 [Patent Document 4] U.S. Patent No. 8,277,833 [Patent Document 5] US Patent Application Publication No. 2005 / 0181011 [Patent Document 6] U.S. Patent No. 5,716,981 [Patent Document 7] U.S. Patent No. 6,852,153 [Patent Document 8] U.S. Patent No. 7,942,923 [Patent Document 9] U.S. Patent No. 7,753,947 [Patent Document 10] U.S. Patent No. 7,879,082 [Patent Document 11] U.S. Patent No. 8,287,588 [Patent Document 12] U.S. Patent No. 5,749,824 [Patent Document 13] International Publication No. 98 / 36709 Brochure Summary of the Invention [Problem to be solved by the invention]

[0011] Unfortunately, the majority of a patient's recovery period occurs between hospital or clinic visits. Therefore, it can be extremely difficult to accurately measure and follow the progression or worsening of symptoms and to correlate "real-life" stent performance with the patient's activity level, exercise tolerance, rehabilitation program, and medications. For much of this information, physicians rely on patient self-reporting to gain insight into postoperative treatment effectiveness and recovery and rehabilitation progress; this is often further complicated by patients being unclear about what to expect, unfamiliar with "normal / expected" postoperative recovery, non-compliance, or unable to effectively communicate these symptoms. Furthermore, identifying and tracking complications (in and out of the hospital) before they become symptomatic and occur between physician visits, or complications whose presence is difficult (or impossible) to detect, would also provide valuable additional information for the management of stent patients. Currently, neither physicians nor patients have access to the type of "real-time," continuous, and objective stent performance measurement they might otherwise have. The ability to monitor stent function in situ can provide useful objective information to the physician during office visits, and further allows the patient to take additional readings at home at various times (e.g., when experiencing pain, during exercise, after taking medication, etc.) to provide the physician with important complementary clinical information (which can be sent electronically to the healthcare provider even from a remote location), and can provide the patient with an early warning indicator to seek assistance or provide reassurance.

[0012] The present invention provides novel stents that overcome many of the problems of conventional stents, methods for constructing and utilizing these novel stents, and provides other related advantages.

[0013] Briefly, an assembly is provided that includes a stent and a sensor for monitoring, among other things, the anatomy of the tissue surrounding the stent (and the general health of the tissue), the health or effectiveness of the stent, the complete opening and correct deployment of the stent, the relationship of the stent to other stents or stent segments, a disease process, the movement of bodily fluids through the stent, the healing of the stent in the body, failure or impending failure of the stent due to disease or other processes (e.g., restenosis, inflammation, benign or malignant tumor growth, blood clot formation), trauma, or an interventional procedure (e.g., surgery). Representative stents suitable for use in the present invention include, for example, vascular (e.g., coronary, carotid, cerebral, vertebral, renal, iliac, mesenteric, arteries of the upper and lower limbs, and branches and veins of all of the aforementioned arterial vessels) stents, gastrointestinal (e.g., esophageal, biliary, duodenal, colonic, and pancreatic) stents, pulmonary (e.g., to keep the trachea, bronchi, bronchioles, or alveoli open), head and neck (sinuses, lacrimal ducts, tympanic cavity) stents, and genitourinary (e.g., ureter, urethra, fallopian tubes, prostate) stents.

[0014] In one aspect of the present invention, an assembly is provided that includes a stent and a sensor disposed on or within the stent. Such stents can be deployed in a variety of lumens, including natural body passageways (e.g., the vascular system, e.g., coronary, cervical, cerebro, and vertebral vessels, as well as renal and iliac vessels, and various arteries of the lower extremities; pulmonary airways (e.g., trachea, bronchi, and other airways in the lungs, including bronchioles or alveoli); gastrointestinal structures (e.g., esophagus, duodenum, small intestine, colon, biliary tract, and pancreatic duct); head and neck (sinuses, lacrimal ducts, tympanostomy tubes); and genitourinary tract (ureters, urethra, fallopian tubes, prostate)), surgically created body passageways (cerebral shunts, spinal shunts, pulmonary shunts, liver shunts, ileostomy, colostomy, surgical drains, tympanostomy tubes), and passageways created or caused by trauma or disease processes.

[0015] According to various embodiments, the assembly includes a stent and one or more sensors disposed on or within the stent, including, for example, one or more sensors disposed on the outer wall of the stent, on the inner wall of the stent, and / or within the stent material itself. In related embodiments, the one or more sensors may be disposed on a luminal surface, a paraluminal surface, and / or may be implanted within the stent or may be implanted within the stent itself.

[0016] A wide variety of sensors can be utilized in the present invention, including, for example, fluid pressure sensors, contact sensors, position sensors, accelerometers, vibration sensors, pulse pressure sensors, blood volume sensors, blood flow sensors, blood chemistry sensors, blood metabolism sensors, mechanical stress sensors, and temperature sensors. In one embodiment, the sensors can be coupled to other medical devices that can be used to deliver one or more medications. In other embodiments, one or more sensors can be wireless sensors and / or sensors connected to a wireless microprocessor.

[0017] In particularly preferred embodiments, multiple sensors are disposed on the stent, and in still other embodiments, more than one type of sensor is disposed on the stent. In other related embodiments, the multiple sensors are disposed on or within the stent at a density of 1 or more, 2 or more, 3 or more, 4 or more, 5 or more, 6 or more, 7 or more, 8 or more, 9 or more, 10 or more, or 20 or more sensors per square centimeter. In other embodiments, the multiple sensors are disposed on or within the stent at a density of 1 or more, 2 or more, 3 or more, 4 or more, 5 or more, 6 or more, 7 or more, 8 or more, 9 or more, 10 or more, or 20 or more sensors per cubic centimeter. In any of these embodiments, there may be fewer than 50, fewer than 75, fewer than 100, or fewer than 200 sensors per square centimeter or cubic centimeter.

[0018] In other embodiments of the invention, each assembly has a unique sensor or device identification number. In another embodiment, one or more (or each) of the sensors has a unique sensor identification number. In yet another embodiment, one or more (or each) of the sensors is uniquely defined within a specific location on or within the stent.

[0019] In yet another aspect of the present invention, an assembly is provided that includes a stent and one or more of the sensors provided herein, where the sensor measures or detects one or more measures of cardiac function, including, for example, cardiac output, stroke volume, ejection fraction, systolic blood pressure, diastolic blood pressure, mean arterial pressure, systemic vascular resistance, total peripheral resistance, temperature, and / or restenosis, blood clots, or partial or total occlusion of luminal fluid flow within a patient. In another aspect of the present invention, an assembly is provided that includes a stent and one or more of the sensors provided herein, where the sensor measures or detects surface (luminal) contact, which can measure healing (for vascular stents, this is typically endothelialization) and the extent / extent of coverage of the stent's lumen surface by biological tissue, and such information can be used by a physician to determine whether the patient remains at risk for thrombosis and whether anticoagulant therapy needs to be continued.

[0020] In certain embodiments of the present invention, the stent is a drug-eluting stent, which may optionally be coated with or include one or more polymers.

[0021] In another aspect of the invention, the use of the assemblies described herein is provided for measuring cardiac function (as described herein) and / or for medical imaging and / or self-diagnosis of one or more aspects of cardiac function, disease, stent health and / or stent efficacy.

[0022] In another aspect of the invention, a method of monitoring a stent is provided, the method comprising the steps of: a) transmitting a wireless electrical signal from a location external to a human body to a location internal to the human body; b) receiving the signal at a sensor disposed on a stent within the human body; c) powering the sensor using the received signal; d) detecting data at the sensor; and e) outputting the detected data from the sensor to a receiving unit external to the human body. In various embodiments, the stent can be configured in any of the assemblies provided herein.

[0023] In another aspect, a non-transitory computer-readable storage medium having stored content configuring a computing system to perform a method, the method including: a) identifying a patient, the identified patient having at least one wireless stent, each wireless stent having one or more wireless sensors; b) directing a wireless interrogation unit to collect sensor data from at least one of the one or more wireless sensors; and c) receiving the collected sensor data. In certain embodiments, the method may optionally further include: a) identifying a plurality of patients, each identified patient having at least one wireless stent, each wireless stent having one or more wireless sensors; b) directing a wireless interrogation unit associated with each identified patient to collect sensor data from at least one of the one or more wireless sensors; c) receiving the collected sensor data; and d) aggregating the collected sensor data. In yet another embodiment, such a method may optionally further include the steps of: a) removing sensitive patient data from the collected sensor data; and b) parsing the collected data according to the sensor format. In a related embodiment, the stored content configures a computing system to perform the method, and the step of instructing the wireless interrogation unit includes instructing a control unit associated with the wireless interrogation unit. Any of the assemblies, stents, and / or sensors described herein may be utilized in such a method.

[0024] In another aspect of the invention, a method for determining stent degradation is provided, the method comprising the steps of: a) providing to a body passageway of a patient an assembly including a stent and one or more sensors disposed on the surface of the stent and / or at various depths within the biodegradable / bioerodible stent; and b) detecting changes in the sensors, thereby determining the rate of degradation and / or complete degradation of the stent. In various embodiments, the sensors may detect one or more physiological (e.g., contact, fluid flow, pressure, and / or temperature) and / or location (e.g., location within the patient's body) parameters. In another embodiment, the detecting step is a series of detections over time, and optionally the method may further include determining the rate of stent degradation and / or estimating the time for complete degradation of the stent.

[0025] In yet another aspect of the invention, there is provided a method of imaging a stent or an assembly including a stent with sensors, the method comprising detecting changes over time in sensors in, on, and / or within the stent, wherein the stent has sensors at a density of 1 or more, 2 or more, 3 or more, 4 or more, 5 or more, 6 or more, 7 or more, 8 or more, 9 or more, 10 or more, or 20 or more sensors per square centimeter. In another aspect, the stent has sensors at a density of 1 or more, 2 or more, 3 or more, 4 or more, 5 or more, 6 or more, 7 or more, 8 or more, 9 or more, 10 or more, or 20 or more sensors per cubic centimeter. In any of these embodiments, there may be fewer than 50, fewer than 75, fewer than 100, or fewer than 200 sensors per square centimeter or cubic centimeter.

[0026] As mentioned above, a wide variety of sensors can be utilized in the present invention, including, for example, fluid pressure sensors, contact sensors, position sensors, accelerometers, vibration sensors, pulse pressure sensors, blood volume sensors, blood flow sensors, blood chemistry sensors, blood metabolism sensors, mechanical stress sensors, and temperature sensors. In various embodiments, the stent can be a vascular stent, a gastrointestinal stent, a pulmonary stent, a sinus stent, or a genitourinary stent, and can optionally be biodegradable, partially biodegradable, or non-degradable. In yet another embodiment, the sensor is a wireless sensor and / or a sensor connected to a wireless microprocessor. By imaging the sensor in this manner, the health of the stent can be wirelessly interrogated and the results can be periodically reported. This allows the patient's health to be checked periodically or at any time desired by the patient and / or physician.

[0027] The details of one or more embodiments are set forth in the following detailed description. Other features, objects, and advantages will be apparent from the specification, drawings, and claims. Additionally, all patents and published patent applications cited herein are incorporated by reference, and the disclosures of each are incorporated by reference in their entirety. [Brief explanation of the drawings]

[0028] [Figure 1] FIG. 1 illustrates an exemplary stent equipped with sensors (including blood flow sensors, pulse pressure sensors, position sensors or location markers, and / or pH sensors). [Figure 2] FIG. 1 is a diagram of an exemplary stent containing a sensor, illustrating the movement of blood through the stent. [Figure 3A] FIG. 1 illustrates an exemplary stent having various openings in the stent struts. [Figure 3B] FIG. 10 illustrates placement of one or more sensors within one of the openings in the strut. [Figure 4A]FIG. 1 illustrates a bifurcation where stenosis occurs at multiple points within a blood vessel. [Figure 4B] FIG. 1 shows a stent with PTCA. [Figure 4C] FIG. 1 shows a stent-plus-stent deployment (also called "reverse-T"). [Figure 4D] Figure 1 shows a stent-plus-stent deployment (referred to as "T-stent placement"). [Figure 4E] Figure 1 shows a stent-plus-stent deployment condition called "crush." [Figure 4F] FIG. 1 shows a stent-plus-stent deployment state, referred to as a "Y" or "V." [Figure 4G] This shows the stent-plus-stent deployment state, called "kissing." [Figure 4H] Figure 1 shows a stent-plus-stent deployment called a "culotte." [Figure 5] 10 is a schematic representation of a contact sensor that may be utilized to facilitate and / or assist in the placement of overlapping stents. [Figure 6] FIG. 1 illustrates medical imaging of vascular anatomy with sensors capable of detecting positional motion. [Figure 7] FIG. 1 illustrates medical imaging of the vasculature with sensors capable of detecting positional movement due to vascular pathological features. [Figure 8] FIG. 1 illustrates an information and communications technology system embodiment configured for processing sensor data. [Figure 9] FIG. 2 is a block diagram of a sensor, an interrogation module, and a control unit according to one embodiment of the present invention. [Figure 10] 1 is a schematic illustration of one or more sensors positioned on a stent within a patient's body being probed to acquire and output data in accordance with the present invention. DETAILED DESCRIPTION OF THE INVENTION

[0029] As mentioned above, the stent is equipped with a number of sensors for monitoring the correct placement and deployment of the stent within the body, the anatomy and pathology of the tissue surrounding the stent, the health and effectiveness of the stent, the normal and abnormal healing of the tissue in contact with the stent, the function of the tissue and organ system in contact with the stent, the degradation and dissolution of the stent (in the case of degradable stents), and the failure or impending failure of the stent due to disease or other processes (e.g., restenosis, thrombosis, inflammation, benign or malignant tumor growth). However, before describing the invention, it may be helpful to an understanding of the invention to first provide definitions of certain terms that will be used hereinafter.

[0030] "Stent" means a medical device that can be used to hold open bodily structures and / or body passageways, and can be used to treat and / or prevent a wide variety of diseases and / or conditions that result from luminal narrowing or obstruction, whether due to trauma or external compression of the blood vessel wall (benign or malignant tumors, abscesses, cysts), due to disease processes occurring within the blood vessel wall (e.g., cancer, atherosclerosis, inflammation, scarring, or stenosis) and / or due to disease processes occurring on the surface (or within) the blood vessel wall (thrombus, atherosclerosis, restenosis, tumor growth, inflammation and scarring, gallstones, urinary "stones," mucosal impaction, etc.), and / or due to surgery or other medical intervention.

[0031] Stents are used in a wide variety of tubular body passages to maintain the normal passage of intraluminal materials (blood, digestive contents, digestive enzymes and bile, air, urine, reproductive materials), including, for example, vascular structures (e.g., coronary arteries, carotid arteries, cerebral arteries, vertebral arteries, iliac arteries, femoral arteries, popliteal arteries, tibial arteries, mesenteric arteries, pulmonary arteries, and other branches of these arteries; large veins, e.g., superior vena cava, inferior vena cava, veins of the neck, upper and lower extremities); digestive structures; (e.g., esophagus, duodenum, small intestine, colon, biliary tract, and pancreatic duct), pulmonary structures (e.g., to keep the trachea, bronchi, bronchioles, or alveoli open), urinary system structures (collecting system, ureters, urethra), female and male reproductive system structures (e.g., to keep the fallopian tubes, prostatic urethra open), sinus structures in the head and skull (maxillary sinuses, frontal sinuses, lacrimal ducts), and inner ear structures (tympanostomy tubes).

[0032] Typically, stents are constructed of metallic or polymeric components and may have a single structure or multiple components (e.g., bifurcated stent systems). Stents may be non-degradable, partially degradable, or fully degradable. Additionally, stents may be coated with one or more different compositions, including both polymers and drugs (including biologics and stem cells). Representative examples of stents include those described in U.S. Pat. Nos. 6,852,153, 7,942,923, 7,753,947, 7,879,082, and 8,287,588, as well as various publications (see, for example, Craig S. Bonsignore, "Open Stent Design: Design and Analysis of Self Expanding Cardiovascular Stents," CreateSpace Independent Publishing Platform, November 2012, and Sigwart, Frank (eds.), "Coronary Stents"). ),” Springer, 2012).

[0033] According to a preferred embodiment, the stents of the present invention have a unique device identification number ("UDI") and each of the sensors on the stent has a unique sensor identification number ("USI").

[0034] "Sensor" refers to a device that can be used to measure one or more different aspects of the human body, a stent inserted therein, and / or the health, impact, effectiveness, or performance of a stent inserted therein. Representative examples of sensors suitable for use in the present invention include, for example, fluid pressure sensors, contact sensors, position sensors, pulse pressure sensors, blood volume sensors, blood flow sensors, chemical sensors (e.g., for blood and / or other bodily fluids), metabolic sensors (e.g., for blood and / or other bodily fluids), accelerometers, mechanical stress sensors, and temperature sensors. In certain embodiments, the sensors may be wireless sensors, or in other embodiments, the sensors may be connected to a wireless microprocessor. In another embodiment, one or more (including all) of the sensors may have a unique sensor identification number ("USI") that specifically identifies the sensor.

[0035] A wide variety of sensors (also known as Microelectromechanical Systems or "MEMS" or Nanoelectromechanical Systems or "NEMS" and BioMEMS or BioNEMS) are generally described as follows: https: / / en.wikipedia.org / wiki / MEMS(See, for example, U.S. Pat. No. 7,383,071 and U.S. Patent Application Publication No. 2010 / 0285082) can be used in the present invention. Representative publications include Albert Foch, "Introduction to BioMEMS", CRC Press, 2013; Marc J. Madow, "From MEMS to Bio-MEMS and Bio-NEMS: Manufacturing Techniques and Applications", CRC Press, 2011; Simona Badilescu, "Bio-MEMS: Science and Engineering Perspectives", CRC Press, 2011; and Steven S. Saliterman. S. Saliterman), "Fundamentals of BioMEMS and Medical Microdevices", SPIE - The International Society of Optical Engineering, 2006, Wanjunn Wang, Steven A. SoperSoper, ed., "Bio-MEMS: Technologies and Applications", CRC Press, 2012; Volker Kempe, "Inertial MEMS: Principles and Practice", Cambridge University Press, 2011; Polla, DL et al., "Microdevices in Medicine", Ann. Rev. Biomed. Eng., 2000, Vol. 2, pp. 551-576; Yun, KS et al. al.), "A Surface-Tension Driven Micropump for Low-Voltage and Low Power Operations," J. Microelectromechanical Sys., October 2002, 11:5. Yeh, R. et al., "Single Mask, Large Force, and Large Displacement Electrostatic Linear Inchworm Motors," J. Microelectromechanical Sys., August 2002, 11:4, pp.330-336. Loh, NC et al., "Sub-10 cm. 3Interferometric Accelerometer with Nano-G Resolution (Sub-10cm 3 "Interferometric Accelerometer with Nano-g Rsolution," J. Microelectromechanical Sys., June 2002, 11:3, pp. 182-187, all of which publications are incorporated by reference herein in their entireties.

[0036] To further understand the various aspects of the invention provided herein, the following sections are provided below: A. Stents and Stent Uses; B. Sensor-Containing Stents; C. Stent Placement, Deployment, and Connection; D. Partially or Wholly Biodegradable Stents; E. Stent Coatings; F. Drug-Eluting Stents; G. Methods for Monitoring In-Stent Infection; H. Further Uses of Sensor-Containing Stents in Healthcare; I. Power Generation from Stents; J. Medical Imaging and Self-Diagnostics, Predictive Analysis, and Predictive Maintenance of Assemblies Including Stents; K. Methods for Monitoring Assemblies Including Stents; and L. Data Collection, Transmission, Analysis, and Distribution from Assemblies Including Stents.

[0037] A. Stents and their uses As mentioned above, stents are used to maintain open the lumen of diseased body passageways (e.g., arteries, the digestive tract, the urinary tract), but have found greatest utility in the vascular system. Briefly, stents may be inserted into body lumens to physically hold open structures and / or passageways (typically tubular organ structures, such as blood vessels, the digestive tract, the urinary tract, intracranial sinuses, airways, or the male and female reproductive tracts) that have become closed or partially occluded, thereby reducing or preventing the passage (typically of liquids, solids, or air). Stents are typically placed percutaneously (e.g., a vascular stent is inserted into the vascular system through the femoral artery in the groin and then manipulated in the bloodstream under X-ray guidance until the stent reaches the diseased blood vessel) or by insertion through a natural orifice (e.g., the mouth, nose, anus) and then positioned under direct vision (endoscopy) into the diseased organ. In most cases, stents are delivered to the deployment site in a compressed form and then expanded in place (often by inflating a balloon or using a "self-expanding" stent), thereby opening the organ lumen and returning it to its original size and shape. Symptoms of obstruction or occlusion (e.g., chest pain, claudication, neurological deficits, dysphagia, intestinal obstruction, jaundice, respiratory distress, infertility, urinary obstruction, sinus pain) are determined in the diseased organ, and restoration of normal anatomy and lumen function is the goal of stent therapy. Stent failure can have many causes, including events such as improper placement, improper sizing, incomplete opening or deployment, tissue ingrowth into the stent lumen (restenosis, tumor cell growth, inflammation), luminal obstruction (blood clots, gallstones, kidney stones), stent fracture, stent entanglement, and stent migration. A stent containing sensors that can assist the physician in proper placement and that can be continuously monitored to detect evidence of partial and / or complete occlusion would have significant advantages over existing devices.

[0038] Figure 1 shows a representative stent containing sensors. Figure 2 shows how some of the sensors are positioned in locations where they will be exposed to blood flowing through the stent. A wide variety of sensors can be positioned on the inner wall (luminal wall) of the stent, within the stent, and / or on the outer wall (paraluminal wall) of the stent. Typical sensors that can be used within a stent include fluid pressure sensors, contact sensors, position sensors, pulse pressure sensors, blood volume sensors, blood flow sensors, blood chemistry sensors, blood (and tissue) metabolism sensors, accelerometers, mechanical stress sensors, vibration sensors, and temperature sensors.

[0039] According to various embodiments, the vascular stents of the present invention (coronary, peripheral, and cerebrovascular) can include various sensors capable of detecting and distinguishing between stenosis, restenosis, and / or normal vascular healing from thrombosis. Blood flow, fluid pressure, and blood volume sensors on the luminal surface can detect the presence and location of a stenosis due to increased blood flow velocity and increased blood pressure (and pulse pressure) (relative to normal pressure) at the stenosis site. Stenosis due to neointimal hyperplasia or clot formation may be detected as a "dead spot" on the vessel surface and / or altered readings when the blood flow, blood metabolism, and / or blood chemistry sensors become covered by vascular tissue or clots, whereas paraluminal pressure sensors and accelerometers do not indicate changes in paraluminal pressure or stent wall deformation. Metabolic or chemical sensors can differentiate between stenosis (normal pH and physiological readings) and clot formation (lowered pH and altered physiological readings). Finally, complete coverage of the luminal surface of the stent in the absence of changes in pressure, blood flow, stent deformation, and metabolic / chemical readings suggests successful healing, with the stent becoming endothelialized (covered with the cells that line the body's blood vessels). This indication of healthy and complete incorporation of the stent into the vessel wall (i.e., the stent is no longer exposed to the elements of the bloodstream) has important clinical consequences—it alerts the physician to discontinue the patient's (costly and dangerous) anticoagulation therapy, as the risk of subacute and delayed thrombosis is now significantly reduced. In the case of biodegradable stents, complete coverage of the luminal surface of the stent and incorporation of the stent into the vessel wall means that dissolution of the stent is now safe (i.e., stent debris will not be released into the bloodstream).

[0040] In addition, patients requiring stents often suffer from comprehensive cardiovascular disease that results in cardiac and systemic circulatory dysfunction. For example, patients receiving stents are at increased risk for myocardial infarction (heart attack), cerebrovascular accident (stroke), congestive heart failure, renal failure, and arrhythmias. The coronary arteries are critical to cardiac function, and therefore monitoring certain hemodynamic and metabolic parameters within these arteries can provide physicians with vital information regarding a patient's cardiac, renal, and circulatory function. The coronary stents of the present invention can include fluid pressure sensors, contact sensors, position sensors, pulse pressure sensors, blood volume sensors, blood flow sensors, blood chemistry sensors, blood metabolism sensors, accelerometers, mechanical stress sensors, temperature sensors, and the like, suitable for such purposes. Representative stents of the present invention can be utilized by those skilled in the art to calculate and monitor important physiological parameters, such as cardiac output (CO), stroke volume (SV), ejection fraction (EV), systolic blood pressure (sBP), diastolic blood pressure (dBP), mean arterial pressure (mAP), systemic vascular resistance (SVR), total peripheral resistance (TPV), and pulse pressure (PP). For example, FloTrac / Vigileo (Edwards Life Sciences, Irvine, Calif.) uses pulse contour analysis to calculate stroke volume (SV) and systemic vascular resistance (SVR), and pressure recording and analysis (PRAM) is used by Most Care (Padra Vitec, Italy) to estimate cardiac output (CO) from analysis of arterial pressure waveforms. Changes in cardiac output (CO), stroke volume (SV), and ejection fraction (EF), as well as cardiac index (CI), can be important in detecting complications such as myocardial ischemia and myocardial infarction, and can also assist physicians in administering and adjusting cardiac medications and dosages. Pulse pressure sensors, pulse contour sensors, and heart rate sensors provided on and within the stents of the present invention can aid in the detection and monitoring of cardiac arrhythmias and heart rate abnormalities, and can also be used to monitor a patient's response to cardiac medications that affect heart rate and rhythm.Systolic blood pressure (sBP), diastolic blood pressure (dBP), mean arterial pressure (mAP), systemic vascular resistance (SVR), and total peripheral resistance (TPV) readings can be used by physicians to monitor the dosage and effectiveness of antihypertensive and vasopressor (blood pressure increasing) medications. Obviously, peripheral and cerebrovascular stents implanted in other arteries (renal, iliac, femoral, carotid, etc.) can also monitor virtually all of the above parameters.

[0041] The vascular stent of the present invention can include cardiovascular sensors (described herein) suitable for monitoring renal function, as well as blood chemistry and blood metabolism sensors. Examples of blood chemistry and metabolism sensors useful in this embodiment include, but are not limited to, blood urea nitrogen (BUN) sensors, creatinine (Cr) sensors, and electrolyte (calcium, potassium, phosphorus, sodium, etc.) sensors. Furthermore, by combining metabolic data with hemodynamic data and urinalysis results, physicians can calculate glomerular filtration rate (GFR), a highly useful measure of renal function. This information is particularly useful in managing dialysis patients to monitor the timing, effectiveness, and frequency of dialysis therapy.

[0042] In one embodiment of the present invention, the stent may further include one or more temperature sensors that can be used to track both the individual temperatures of the blood, the vessel wall, and the surrounding environment, as well as changes in temperature over time. Such temperature changes can be used to diagnose the potential for an infection (or other disease or condition) to develop, allowing a physician or caregiver to treat the infection (or other disease or condition) before it fully develops.

[0043] B. A stent containing a sensor As noted above, in various aspects of the present invention, the sensors described herein may be housed within a stent, such as within holes in the struts of the stent or within the struts themselves. As used herein, the term "hole" should be understood to include openings extending completely through the stent as well as voids, recesses, wells, or other openings or partial openings that allow for insertion of a sensor within the stent. Representative examples of stents include those described in U.S. Patent Nos. 7,208,010 and 7,179,289.

[0044] For example, as shown in Figure 3A, a representative stent includes various holes in the stent struts, and Figure 3B illustrates the placement of one or more sensors housed within one of the strut openings.

[0045] C. Stent placement, deployment and ligation In certain embodiments, the stents of the present invention can provide detection information to serve a variety of important clinical functions. It is widely recognized that the greater the amount of trauma experienced by the vessel wall during stent placement and deployment, the greater the likelihood that the stent will eventually become occluded (e.g., due to restenosis). Causes of vascular trauma during placement include inaccurate sizing (a stent that is too large for the vessel), difficult placement and deployment (requiring extensive manipulation to place the stent), long lesions, overlapping stents, balloon over-inflation or stent over-expansion, complex lesions (including stent placement at bifurcations), and placement of stents in tortuous vessels. Accurate placement, sizing, deployment, and sufficient expansion of stents continues to be a challenge, particularly in the vascular system, where primarily indirect visualization techniques, such as angiography, are used for stent placement; angiography (radiopaque dye flowing through the bloodstream) shows only the vascular luminal anatomy and does not provide information about vessel wall abnormalities, which are often the critical diseased segment being treated. "Real-time" sensing information from the stent itself is useful to the physician during stent placement to determine whether the stent is anatomically correctly implanted, whether the stent is properly sized for the resulting stent placement, whether the stent will fully open (deploy) upon balloon expansion (or self-expansion), whether the stent exerts too much (or too little) pressure on the vessel wall, whether the stent segments are assembled correctly, whether the amount of overlap between adjacent stents is optimal, whether there is stent entanglement or deformation, whether there is stent cracking or breakage, and whether there is uniform flow through the device, to name just a few important functions. The stent of the present invention allows the operating physician to monitor many useful parameters that can result in successful and minimally traumatic stent placement and deployment.

[0046] Improper sizing of a stent relative to the vessel wall in which it is placed can significantly increase the risk of fracture (especially due to restenosis); stents equipped with sensors capable of detecting pressure against the vessel wall and the amount, presence, and / or absence of contact with the vessel wall can help match the stent size and degree of expansion (deployment) to the vessel wall size. Incomplete or partial stent deployment (referred to as incomplete malapposition—areas where the stent does not adequately contact the vessel wall and protrudes into the arterial lumen) increases the risk of subsequent blood clotting (thrombosis) and stent fracture; position sensors, contact sensors, and accelerometers on the stent can be used to locate and correct areas of incomplete deployment during stent insertion; "locking" into the fully deployed position can be confirmed by sensors on and within the device. Improper stent positioning (malpositioning), either at the time of deployment or due to subsequent movement / migration, is also a common complication of stent therapy. The sensor-containing stents of the present invention can be used to confirm proper initial placement and subsequent migration or dislocation within the vessel. Overall stent movement or detachment of individual stent segments from one another is another complication of stent insertion and current therapy. The stents of the present invention have the ability to detect overall stent movement / detachment as well as movement and / or detachment of individual segments (or fragments), providing useful diagnostic information to physicians and patients. Stent entanglement as a result of subsequent movement during and / or after deployment is also a significant clinical problem when it occurs. The stents of the present invention have position sensors and accelerometers distributed throughout the stent that can detect stent deformation and entanglement. Stent cracking and fracture can be a problem with all stents, but can be particularly problematic in peripheral stents in the lower extremities (due to leg movement or stent bending across the knee joint) and polymeric degrading stents.Vibration sensors, position sensors, location sensors and accelerometers throughout the instrument can alert the physician and patient to this developing complication before it becomes an emergency situation.

[0047] Various aspects of the present invention provide assemblies in which a stent may be a single component combined with another stent or comprise multiple components that must be properly positioned to ensure proper efficacy. When a patient has arterial disease and a vascular stenosis at a bifurcation in the vascular tree, it is often necessary to use stents (or stent components) that can be deployed together in situ to match the anatomy of the occluded segment. For example, Figure 4 shows a schematic representation of various types of stent deployment, where contact sensors can be used to ensure proper stent placement. Figure 4A illustrates a bifurcation where stenosis occurs at multiple locations within a vessel. Figure 4B illustrates a stent with PTCA. Figure 4C illustrates a stent-plus-stent deployment (also known as a "reverse-T"). Figure 4D illustrates a stent-plus-stent deployment (referred to as "T stenting"). Figure 4E illustrates a stent-plus-stent deployment referred to as "Crush." Figure 4F illustrates a stent-plus-stent deployment state, referred to as a "Y" or "V." Figure 4G illustrates a stent-plus-stent deployment state, referred to as a "kissing." Figure 4H illustrates a stent-plus-stent deployment state, referred to as a "culotte." In each case, contact sensors (potentially "matched" or complementary) can be used to confirm correct assembly, accelerometers can confirm anatomical location and structure, position sensors can monitor motion, flow sensors can confirm vessel patency, and pressure / vessel wall sensors can confirm complete deployment and accurate vessel size. Collectively, this sensing information can create a three-dimensional image of the vessel and stent anatomy, thus significantly improving the data available from angiography alone. This dramatically increases the likelihood of accurate, safe, and effective deployment of multiple stents within complex vascular lesions.

[0048] FIG. 5 is a schematic diagram of a contact sensor that can be used to facilitate and / or assist in the placement of overlapping stents. Overlapping stents are used to treat long or tortuous lesions where a single stent is insufficient to span the entire length of the diseased segment. While often effective, overlapping stents are more prone to failure, with the failure rate being directly proportional to the degree of overlap between adjacent stents; too much overlap increases the risk of failure, while too little overlap—especially when there is a gap between the two stents—is similarly problematic. Inter-stent contact sensors can be used to confirm both the presence and degree of overlap between adjacent stents. In a preferred embodiment, the inter-stent contact sensors are “matched,” or complementary, and can ascertain when the ideal amount of overlap between adjacent stents has been achieved. Additionally, pressure sensors, position sensors and accelerometers can be used to verify that overlapping segments are equally spaced to ensure that there is no lumen size "mismatch" between the two overlapping segments.

[0049] D. Partially or completely biodegradable stents As mentioned above, the stents of the present invention (for blood vessels (e.g., coronary, carotid, cerebral, vertebral, iliac, femoral, and arteries of the lower limbs), gastrointestinal tract (e.g., esophagus, duodenum, colon, biliary tract, and pancreas), pulmonary (e.g., to keep the trachea, bronchi, bronchioles, or alveoli open), head and neck (sinuses, lacrimal duct, tympanic cavity), and genitourinary tract (e.g., ureter, urethra, prostate, fallopian tube)) may be composed of one or more biodegradable polymers. Such stents may be fully or partially biodegradable and / or resorbable. Representative examples of such stents include, for example, those described in U.S. Patent Application Publication Nos. 2009 / 0192588, 2007 / 0270940, and 2003 / 0104030, and U.S. Patent Nos. 6,387,124, 6,869,443, and 7,044,981.

[0050] The placement of sensors described herein on or within a biodegradable or partially biodegradable stent (at various depths within the polymer) allows for the determination of stent degradation and, optionally, the measurement of the stent's biodegradation or resorption rate. Thus, in one aspect of the present invention, a method for determining stent degradation is provided, comprising the steps of: a) providing to a body passageway of a patient an assembly including a stent and one or more sensors disposed on the surface of the stent and / or at various depths within the biodegradable / bioerodible stent; and b) detecting changes in the sensors, thereby determining the rate of degradation and / or complete degradation of the stent. In various embodiments, the sensors can detect one or more physiological (e.g., contact, fluid flow, pressure, and / or temperature) and / or location (e.g., location within the patient's body) parameters. In another embodiment, the detecting step is a series of detections over time, and optionally, the method may further include determining the rate of stent degradation and / or estimating the time for complete degradation of the stent. In yet another embodiment, the stent can determine the degree of lumen coverage of the device by healing tissue, thus confirming that the stent is implanted within the vessel wall (reducing or eliminating the risk of stent debris being released into intraluminal fluids).

[0051] In one embodiment, the biodegradable stent is an esophageal stent, a ureteral stent, a urethral stent, a sinus stent, a vascular stent, or a prostate stent, and the degradation of the stent can be monitored by detecting the loss or movement of a sensor over a period of time.

[0052] E. Stent coating Certain embodiments of the present invention provide stents that may have one or more coatings applied to one or more surfaces of the stent. Coatings may be applied to the stent for a variety of purposes. Coatings may be biodegradable, non-biodegradable, or a combination thereof. Representative examples of coatings are those based on polymers (e.g., polymers composed of polyurethane, polyester, polylactic acid, polyamino acid, polytetrafluoroethylene, Teflon®, and Gortex®), although non-polymeric coatings may also be utilized.

[0053] Representative examples of suitable coatings include those described in, for example, U.S. Pat. Nos. 8,123,799, 8,080,051, 8,001,925, 7,553,923, and 5,779,729, all of which are incorporated by reference herein in their entireties.

[0054] F. Drug-eluting stents In certain embodiments of the present invention, the stents provided herein may be designed to elute one or more drugs (e.g., biologically active agents), representative examples of which are described in U.S. Patent No. 5,716,981, U.S. Patent Application Publication Nos. 2005 / 0021126 and 2005 / 0171594 (entitled "Stents with bioactive coatings"), and U.S. Patent Application Publication Nos. 2005 / 0181005 and 2005 / 0181009 (entitled "Implantable sensors, implantable pumps, and anti-scarring agents"), all of which are incorporated by reference herein in their entireties.

[0055] Thus, various embodiments of the present invention provide a drug-eluting stent (e.g., a drug-coated stent) that has one or more sensors and can be utilized to release a desired agent (e.g., a drug or therapeutic agent) to a desired location within the body (e.g., a body lumen and / or vessel wall). In related embodiments, a drug-eluting delivery device can be provided within the stent to release the desired agent on demand (e.g., remotely activated / on demand or on a timed schedule, see generally U.S. Patent Application Publication No. 2011 / 0092948, entitled "Remotely Activated Piezoelectric Pump For Delivery of Biological Agents to the Intervertebral Disc and Spine," which is incorporated by reference in its entirety) or upon detection of an activation event (e.g., detection of a leak via a pressure sensor). For example, in certain embodiments of the invention, a biological agent may be administered with or released from the stent to treat or prevent a disease (e.g., i) in the case of cancer, with a chemotherapeutic agent or to inhibit restenosis; ii) in the case of preventing restenosis, with an anti-restenosis drug, such as a taxane or limus drug; or iii) in the case of infection, with an antibacterial drug).

[0056] In a preferred embodiment, one or more sensors (e.g., pressure sensors, contact sensors, and / or position sensors) can be utilized to determine proper placement of the desired agent, as well as the amount of agent to be released at the desired site and the kinematic characteristics of the release.

[0057] G. How to monitor for infection In other embodiments, stents are provided that have one or more temperature sensors. Such stents can be used to measure blood temperature, blood vessel or lumen wall temperature, stent temperature, temperature within the local tissue, and the temperature of the surrounding environment adjacent to the stent. Methods are also provided for monitoring temperature changes over time to determine and / or alert (e.g., to the patient and / or healthcare provider) that an infection may be imminent.

[0058] In certain embodiments of the present invention, metabolic and physical sensors may also be placed on or within the stent or on or within various components of the stent to monitor for rare but potentially life-threatening complications. In some patients, the stent and surrounding tissue may become infected. Sensors, such as temperature sensors (which detect an increase in temperature), pH sensors (which detect a decrease in pH), and other metabolic sensors, may be used to indicate the presence of infection on or around the stent. For example, a temperature sensor may be placed on or within the stent to allow early detection of infection and allow preemptive treatment with antibiotics or surgical intervention.

[0059] H. Further uses of sensor-containing stents in healthcare Sensors on stents and any associated medical devices have various advantages in healthcare settings and non-healthcare settings (e.g., at home or at work). For example, post-operative progress can be monitored (readings can be compared daily, weekly, etc.), and information can be compiled and relayed to both the patient and their physician, allowing rehabilitation to be followed sequentially and compared to expected (typically age-group) norms. In certain embodiments, a wearable device interrogates the sensors in a selected or randomized manner and captures and / or stores the collected sensor data. This data can then be downloaded to another system or device (as described in more detail below).

[0060] By integrating data collected by the sensors described herein (e.g., contact sensors, position sensors, strain gauges, and / or accelerometers) with simple, widely available, commercially available analytical techniques, such as pedometers and global positioning system (GPS) capabilities, further clinically relevant data can be gathered, including, but not limited to, the patient's ambulation level (time, distance, steps, speed, cadence), the patient's activity level (activity frequency, duration, intensity), exercise tolerance (work, calories, power, training effect), range of motion (discussed below), and prosthesis performance under various "real-world" conditions. The value of this information in enabling better management of a patient's recovery is difficult to overstate. The treating physician (or physical therapist or rehabilitation specialist) only observes the patient episodically during scheduled visits, and the patient's degree of function at the precise moment of the visit may be affected by many non-correlated factors, such as the presence or absence of pain, the presence or absence of inflammation, stiffness, time of day, compliance and timing of medications (pain medications, anti-inflammatory medications), recent activity and exercise level, the patient's endurance, mood, language barriers, characteristics of the physician-patient relationship, or the patient's ability to accurately describe their symptoms, to name a few. Continuous monitoring and data collection allow patients and physicians to objectively monitor progress by providing information about the patient's function under many conditions and circumstances, thereby enabling them to assess how performance has been affected by various interventions (pain control, exercise, physical therapy, anti-inflammatory medications, respiration, etc.), and to compare rehabilitation progress with prior and future predicted function. Better treatment decisions and better patient compliance are expected when both physicians and patients have the advantage of observing the effects of various treatment modalities on the patient's rehabilitation, activity, function, and overall performance.

[0061] I. Power generation In certain aspects of the invention, one or more small electrical generating units may be placed in, within and / or on the stent. Briefly, various techniques are described for extracting electrical power from slight mechanical motion or vibration. See, for example, UK Singh et al., "Piezoelectric Power Scavenging of Mechanical Vibration Energy," Australian Mining Technology Conference, October 24, 2007, pp. 111-118, and Chandrakasan et al., "Next Generation Micro-power Systems," Symposium on VLSI Circuits Digest of Technical Papers, 2008, pp. 1-5. See also U.S. Pat. No. 8,283,793 (titled "Device for Energy Harvesting within a Vessel") and U.S. Pat. No. 8,331,632 (titled "Devices, Methods and Systems for Harvesting Energy in the Body"). All of these above-mentioned prior art documents are incorporated herein by reference in their entirety. These references provide examples of different types of power scavengers that can generate electricity from very little motion and store the electricity for later use. The above-mentioned references also describe embodiments in which pressure is applied or removed from a particular structure to generate electricity as a result of the application of high pressure, rather than requiring motion.Additionally, these references describe embodiments in which electricity can be generated from pulsating forces within the body.

[0062] After electricity is generated by one or more electrical generators, the electricity is transmitted to any one of the various sensors described herein. For example, the electricity can be transmitted to the illustrated sensor. This electricity can also be transmitted to other sensors described later in this specification. The transmission of power can be accomplished by any acceptable technique. For example, if the sensor is physically coupled to the stent, an electrical wire can run from the electrical generator to the particular sensor. Alternatively, the electricity can be transmitted wirelessly in the same manner that a wireless smart card receives power from a nearby power source using appropriate transmit and receive antennas. Such power transmission and reception techniques are also described in the above-mentioned publications, published patent applications, and issued U.S. patents, all of which are incorporated by reference herein.

[0063] J. Medical imaging and self-diagnosis, predictive analysis and predictive maintenance of assemblies including stents The present invention provides stents that can be imaged through the use of sensors over a wide variety of conditions. For example, various aspects of the present invention provide methods of imaging a stent or an assembly including a stent with sensors, the methods including detecting changes in sensors in, on, and / or within the stent over time, where the stent has sensors at a density of 1 or more, 2 or more, 3 or more, 4 or more, 5 or more, 6 or more, 7 or more, 8 or more, 9 or more, 10 or more, or 20 or more sensors per square centimeter. In other aspects, the stent has sensors at a density of 1 or more, 2 or more, 3 or more, 4 or more, 5 or more, 6 or more, 7 or more, 8 or more, 9 or more, 10 or more, or 20 or more sensors per cubic centimeter. In any of these embodiments, there may be fewer than 50, fewer than 75, fewer than 100, or 100 sensors per square centimeter or cubic centimeter. As mentioned above, a variety of sensors can be utilized in the present invention, including, for example, fluid pressure sensors, contact sensors, position sensors, pulse pressure sensors, blood volume sensors, blood flow sensors, blood chemistry sensors, blood metabolism sensors, mechanical stress sensors, and temperature sensors.

[0064] For example, using a stent with sensors as described herein, the vascular anatomy and stent structure can be imaged using sensors capable of detecting positional movement. The sensors used may further include accelerometers and motion sensors to detect stent movement due to heartbeat or other physical changes. Changes in the position of the accelerometers and / or motion sensors over time can be used as a measure of changes in the position of the stent wall and / or vessel wall over time. These positional changes can be used as surrogate markers of the vascular anatomy and stent structure—i.e., they can form an “image” of the stent and / or vessel wall to provide information regarding the size, shape, and location of restenosis within the stent, the size, shape, and location of blood clots, tumor growth, abscess formation, atherosclerotic plaque formation, stent kinking, stent fracture, segmented or bifurcated stent detachment, the amount of overlap in overlapping stents, and / or stent movement / migration.

[0065] For example, Figure 7 illustrates a method for medical imaging of the vasculature with a sensor capable of detecting positional movement due to pathological features of the blood vessel, such as restenosis or thrombus formation. By imaging the stent in this manner, the health of the stent can be periodically interrogated wirelessly and the results reported. This allows the health of the patient to be checked periodically or at any time desired by the patient and / or physician, thereby enabling predictive diagnosis and / or predictive maintenance or prevention of the stent.

[0066] Certain exemplary embodiments will now be described in detail. One particular advantage is live, in situ monitoring of a stented patient's recovery. The sensors described herein collect data on a regular basis, during normal daily activities, and even overnight if necessary. For example, a contact sensor may acquire and report data once every 10 seconds, once a minute, or once a day. Other sensors will collect data more frequently, for example, several times a second. For example, it is expected that temperature, contact, and / or position data will be collected and stored several times a second. Other types of data only need to be collected on a minute-by-minute or hourly basis. Still other sensors may collect data only when signaled by the patient as part of an "event record" - i.e., when the patient experiences a particular event (e.g., pain, trauma, etc.) - and may send a signal to an instrument to obtain a reading at that time (by an external signal generating / triggering device), the purpose of which is to allow comparison of subjective / symptomatic data with subjective / sensor data in an attempt to better understand the underlying cause or trigger of the patient's symptoms.

[0067] In certain cases, the stent is of sufficient size and has more than enough space to accommodate one or more processor circuits, CPUs, memory chips, and other electronic circuits, as well as antennas for transmitting and receiving data. In other embodiments, the associated medical device can accommodate one or more processor circuits, CPUs, memory chips, and other electronic circuits, as well as antennas for transmitting and receiving data. The processor can be programmed to collect data from various sensors on any desired schedule set by the medical professional. All procedures can be continuously monitored post-procedure, and data can be collected and stored in memory located within the stent.

[0068] Patients with stents typically undergo periodic health checkups. When the patient visits a doctor's office for a checkup, the doctor places a reader in close proximity to the stent, in this example, the illustrated stent, to transfer data from the internal circuitry within the stent to a database within the doctor's office. The use of wireless transmission using smart cards or other technologies is well known in the art and need not be described in detail. Examples of such wireless data transmission are described in the U.S. patent applications and patents mentioned herein. Collected data (e.g., collected over a short period of time, over weeks, or even over months) is transferred from the memory located within the stent to the doctor's computer or wireless device in a few months. The computer then analyzes the data for abnormalities, unexpected changes over time, positive or negative trends, and other indications of the patient's health and the stent's performance. For example, if the patient decides to go skiing or jogging, the doctor can monitor the effects of such activity on the stent, including changes during the activity. The physician can then examine the health of the stent in the hours and days following the event and compare it to data from before the event to determine whether any particular event caused long-term damage or whether activity subjected the stent to forces that exceed the manufacturer's performance specifications for that particular stent. Data can be collected and compared to the current and long-term performance of the stent from strain gauges, contact sensors, surface wear sensors, or other sensors that may be present. A representative example of an Electronic Data Capture, Documentation, and Clinical Decision Support System (EDDS) is described in International Publication No. WO 2012 / 061825, which is incorporated by reference in its entirety.

[0069] In one variation, patients may also have such a reading device at home, which periodically collates data from the stent, e.g., once a day or once a week. As mentioned above, patients may also "trigger" device readings (via an external signal-generating / triggering device) as part of an "event log." Empowering patients to pursue their own rehabilitation—and allowing them to recognize the positive (and negative) effects of various lifestyle choices on their health and rehabilitation—can potentially improve compliance and patient outcomes. Furthermore, patients' experiences can be shared with other patients via the Web, allowing them to compare their progress with expected "norms" for function and rehabilitation and alert them to signs and symptoms that should be brought to the attention of their physicians. The performance of different stents can be compared in different patients (e.g., with different genders, weights, activity levels, etc.), thereby helping manufacturers design better devices and assisting surgeons and other healthcare providers in selecting the right stent for a particular patient type. Payers, patients, manufacturers, and physicians can all benefit from the collection of this comparative information. Finally, aggregated data can be collected at home and transmitted via the internet to a doctor's office for analysis—potentially eliminating unnecessary visits and potentially facilitating prompt medical follow-up.

[0070] K. How to monitor a stent As mentioned above, the present invention also provides a method for monitoring one or more of the stents provided herein. For example, FIG. 8 illustrates a monitoring system 20 that can be used with a stent 14 of the type shown in any one of FIGS. 1, 2, 3, 4, 5, 6, or 7. The monitoring system 20 includes an operable sensor 22, an interrogation module 24, and a control unit 26. The sensor 22 is of a passive wireless type that can operate with power received from a wireless source. Such sensors are well known and widely available in the art. This type of pressure sensor can be a MEMS pressure sensor, such as part number LPS331AP, available on the open market from STMicroelectronics. MEMS pressure sensors are well known to operate with very little power and are suitable for remaining unpowered and idle for long periods of time. These pressure sensors can be wirelessly powered by an RF signal, and based on the power received wirelessly over the RF signal, these pressure sensors detect pressure and then output the detected data.

[0071] In one embodiment, an electricity generation (power generation) system is provided that can be used to power the sensors described herein (e.g., fluid pressure sensors, contact sensors, position sensors, pulse pressure sensors, blood volume sensors, blood flow sensors, blood chemistry sensors, blood metabolism sensors, accelerometers, mechanical stress sensors, temperature sensors, etc.). For example, the power generation system can utilize pulsating blood flow in blood vessels. Electricity is generated by one or more electrical generators or generators, and then transmitted to any one of the various sensors described herein. For example, the transmission of power can be accomplished by any acceptable technology. For example, an electrical generator can be directly coupled to one or more sensors by electrical wires. Alternatively (or additionally), electricity can be transmitted wirelessly in the same way that a wireless smart card receives power from a nearby power source using appropriate transmit and receive antennas.

[0072] In operation, as shown in Figure 8, the interrogation module 24 outputs a signal 28. The signal 28 is a wireless signal (e.g., a wireless signal in the RF band) that includes power for the sensor 22 and an interrogation request for the sensor 22 to perform detection. Upon interrogation by the signal 28, the sensor 22 wakes up and stores sufficient power in an on-board capacitor to maintain operation during detection and data reporting. Such power receiving circuitry and power storage in an on-board capacitor are well known in the art and therefore need not be described in detail. Appropriate detection is performed by the sensor 22, and data is then output from the sensor and returned to the interrogation module 24 in the form of a signal 30, where the signal 30 is received at an input port of the interrogation module.

[0073] According to one embodiment, sufficient signal strength is provided in the initial signal 28 to power the sensor, perform detection operations, and output a signal back to the interrogation module 24. In other embodiments, two or more signals 28 are sent, each providing sufficient power to the sensor to complete detection operations and then transmit data over signal path 30 back to the interrogation module 24. For example, the signal 28 can be sent continuously with a detection request component in a first portion of the signal, followed by subsequent power to operate the sensor, either as a steady signal or as a pulse. When the sensor is ready to output data, it can send a warning signal to the interrogation module 24 that data is coming and turn off the signal 28 to avoid interference. Alternatively, the interrogation signal 28 can be at a first frequency and the output signal 30 can be at a second frequency that is far enough apart that the signals do not interfere with each other. In a preferred embodiment, both of these signals are at the same frequency so that the same antenna on the sensor can receive signal 28 and transmit signal 30 .

[0074] The interrogation signal 28 may include data for selecting a particular signal on the stent. For example, the signal 28 may activate all sensors on the stent simultaneously, then send a request for data from each at different selected times, so that one interrogation signal 28 is provided for a set period of time, e.g., 1-2 seconds, so that each of the sensors on the stent collects data during this period, and then at the end of the period, reports the data on a respective signal 30 at different times over the next 0.5-2 seconds, so that data from all sensors 22 is collected with one interrogation signal 28.

[0075] The interrogation module 24 operates under the control of a control unit 26, which includes a microprocessor for the controller, memory, I / O circuitry for interfacing with the interrogation module, and a power supply, which outputs data to a computer or other device for display and use by a physician to treat the patient.

[0076] 9 illustrates the operation of an embodiment of the present invention within a patient. The patient has a skin 32. A stent placed within one of the patient's blood vessels is provided inside the patient's body. The stent 14 can be placed in any one of a number of locations within the patient's body. In this example, the stent is a coronary stent placed within the patient's coronary artery (left anterior descending artery), although other vascular stents and non-vascular stents (described above) can be utilized in a similar manner.

[0077] As shown in FIG. 9, the interrogation module 24 and control unit 26 are positioned external to the patient's skin 32. An interrogation signal 28 passes through the patient's skin as a wireless RF signal, and data is received from the sensor 22 on a wireless RF signal 30 and returned to the interrogation module 24. The wireless signal can be in any frequency range, but the RF range is preferred. Frequencies in the VLF-LF range of 3-300 kHz are preferred to allow the signal to travel deep enough into the body with low power, although frequencies below 3 kHz and above 300 kHz can also be used. Detection does not require the transfer of large amounts of data and low power is preferred, so a low-frequency RF signal is safe. This also avoids conflicts with and accidental activation by other wireless signal generators, such as Bluetooth, cell phones, etc.

[0078] L. Collection, transfer, analysis, and distribution of data from the stent FIG. 10 illustrates one embodiment of an information and communications technology (ICT) system 800 configured to process sensor data (e.g., data from sensors 22 of any one of FIGS. 1, 2, 3, 4, 5, 6, or 7). In FIG. 10, ICT system 800 is shown as including computing devices that communicate over a network 804; however, in other embodiments, the computing devices may communicate directly with each other or through other intervening devices, or in some cases, the computing devices may not communicate at all. The computing device of FIG. 10 includes a computing server 802, a control unit 26, a query unit 24, and other devices not shown for clarity.

[0079] 10 , one or more sensors 22 communicate with an interrogation module 24. The interrogation module 24 may be directed by a control unit 26, but in other cases the interrogation module 24 operates autonomously to communicate with and receive information from the sensors 22. One or both of the interrogation module 24 and the control unit 26 may be in communication with a computing server 802.

[0080] In certain embodiments, the interrogation module and / or control unit may be a wearable device attached to the patient. The wearable device (e.g., a watch-like device, a wristband, glasses, or other device portable or wearable by the patient) may interrogate the sensors for set (or random) periods to collect data and transmit the data to one or more networks (804). Additionally, the wearable device may autonomously collect data that may also be transmitted to a network. Representative examples of data that may be collected include location (e.g., GPS), body or skin temperature, and other physiological data (e.g., pulse rate). In yet another embodiment, the wearable device may directly notify the patient of any of a number of predetermined conditions, including, but not limited to, threatened or actual equipment failure.

[0081] The information communicated between interrogation module 24 and sensors 22 may be useful for many purposes described herein. In some cases, for example, sensor data information may be collected and analyzed explicitly for an individual patient's health. In other cases, sensor data may be collected and transmitted to another computing device for aggregation with other data (e.g., sensor data from sensors 22 may be collected and aggregated with other data collected from a wearable device, which may, in certain embodiments, include GPS data, etc.).

[0082] 10 shows a view of computing server 802 as a cooperating bank of servers that further includes computing servers 802a, 802b, and one or more other servers 802n. As will be appreciated, computing server 802 may include any number of computing servers that act individually or collectively for the benefit of users of the computing servers.

[0083] In some embodiments, computing server 802 is configured as a cloud computing service hosted in one or more geographic locations, such as the United States and Canada. The computing service may be hosted as a Microsoft Azure cloud computing service or some other virtually accessible remote computing service.

[0084] The interrogation module 24 and control unit 26 are shown as optionally in communication with a computing server 802. Via the interrogation module 24 or control unit 26, sensor data is transferred over a network 804 to (and additionally or alternatively from) the computing server 802.

[0085] Network 804 may include some or all of a cellular communications network, a conventional cable network, a satellite network, an optical fiber network, and one or more local area networks, wide area networks, personal area networks, etc. configured as a computing network. In a preferred embodiment, network 804 includes any communications hardware and software that cooperate to enable users of computing devices to view and interact with other computing devices.

[0086] The computing server 802 includes a central processing unit (CPU), a digital signal processing unit (DSP) 808, a communications module 810, an input / output (I / O) module 812, and a storage module 814. The components of the computing server 802 are cooperatively coupled to one another by one or more buses 816, which facilitate the transfer of information and control within and through the computing server 802. The communications module 810 can be configured to communicate information between the computing server 802 and other computing devices (e.g., computing servers 802a, 802b, 802n, the control unit 26, the interrogation unit 24, etc.). The I / O module 812 can be configured to receive input from devices such as a keyboard, a computer mouse, a trackball, etc. The I / O module 812 can be configured to provide output to devices such as a display, a recorder, an LED, an audio device, etc.

[0087] The storage module 814 may include one or more types of storage media. For example, the storage module 814 of Figure 10 may include a read-write memory (RAM) 818, a read-only memory (ROM) 820, a disk-based memory 822, an optical memory 824, and other types of memory storage media 826. In some embodiments, one or more database structures are configured on one or more of the storage devices in the storage module 814. The database structures may be used to store data collected from the sensors 22.

[0088] In some embodiments, the storage module 814 may further include one or more portions of memory organized as a non-transitory computer-readable medium (CRM). The CRM is configured to store computer-computational instructions executable by the CPU 808. The computer-computational instructions may be stored as one or more files, each of which may include one or more computer programs. The computer programs may be stand-alone programs or part of a larger computer program. Alternatively or additionally, each file may include data or other computer-computational support material for an application that directs the collection, analysis, processing, and / or distribution of data from a sensor (e.g., a sensor on a stent). A sensor data application typically executes a set of instructions stored on a computer-readable medium.

[0089] It should be understood that the computing server shown and described herein is exemplary only and does not limit the scope of the present invention. Computing server 802 can be connected to other devices, not shown, including via one or more networks, such as via the Internet or via a Web integrated into network 804. Generally speaking, a computing system or device (e.g., a "client" or "server"), or any portion thereof, can include any combination of hardware, optionally programmed or otherwise configured with software, capable of interacting with each other to perform functions of the type described, including, but not limited to, desktop or other types of computers, database servers, network storage devices and other network devices, PDAs (personal digital assistants), cellular phones, wireless phones, pagers, electronic organizers, Internet appliances, television-based systems (e.g., set-top boxes and / or personal / digital video recorders), and various other products that include appropriate local area communication capabilities. Additionally, the functionality provided by the illustrated system modules may in some embodiments be combined into fewer modules or distributed among additional modules. Similarly, in some embodiments, the functionality of some of the illustrated modules may not be provided and / or other additional functionality may be available.

[0090] Additionally, while various items are shown as being stored in memory or as being stored while in use, these items, or portions of these items, may be transferred between memory and other storage devices for purposes of memory management and / or data integrity. In at least some embodiments, the illustrated modules and / or systems are software modules / systems that include software instructions that, when executed by a CPU / DSP 808 or other processor, program the processor to automatically perform the described operations for the module / system. Alternatively, in other embodiments, some or all of the software modules and / or systems may operate in memory located on another device and communicate information with the illustrated computing system / device via intercomputer communications.

[0091] Furthermore, in some embodiments, some or all of the modules and / or systems may be implemented or provided in other ways, for example, at least partially in firmware and / or hardware means, including, but not limited to, one or more application specific integrated circuits (ASICs), standard integrated circuits, controllers (e.g., by executing appropriate instructions, and including microcontrollers and embedded controllers), field programmable gate arrays (FPGAs), complex programmable logic devices (CPLDs), etc. Some or all of the systems, modules, or data structures may also be stored (e.g., as software instructions or structured data) on a transient or non-transitory computer-readable storage medium 814, such as a hard disk 822 or flash drive or other non-volatile storage device 826, volatile memory 818, non-volatile memory 820, network storage, or portable media article (e.g., DVD disk, CD disk, optical disk, flash memory device, etc.), to be read by an appropriate input or output system or via a suitable connection scheme. The systems, modules, and data structures may also, in some embodiments, be transmitted as generated data signals (e.g., as carrier waves or other analog or digital propagated signals) over various computer-readable transmission media, including wireless and wired / cabled media. The data signals may take various forms, such as part of a single or multiplexed analog signal, as multiple separate signal packets or frames, as separate or streaming sets of digital bits, or some other form. Such computer program products may take other forms in other embodiments. Accordingly, the present invention may be practiced with other computer system configurations.

[0092] 10, sensor data from, for example, sensor 22 is provided to computing server 802. Generally speaking, the sensor data represents data retrieved from a known patient and a known sensor. The sensor data may include or further be associated with additional information, such as a USI, UDI, timestamp, location (e.g., GPS) stamp, date stamp, and other information. The difference between various sensors is that some may include more or fewer data bits that associate the data with a particular source, collection device, transmission characteristics, etc.

[0093] In some embodiments, the sensor data may include sensitive or delicate information, such as private health information associated with a particular patient. Sensitive information, such as sensor data from sensors 22, may include any information that a party desires not to be widely or easily disclosed. Sensitive information may stand alone or may be combined with other, non-sensitive information. For example, patient medical information is typically sensitive information. In some cases, the storage and transmission of patient medical information is protected by government mandates (e.g., laws, regulations, etc.), such as the Health Insurance Portability and Accountability Act (HIPPA) in the United States.

[0094] As used herein, "sensitive" information includes information that is entirely sensitive and information that is any combination of sensitive and non-sensitive information. Sensitive information may be represented in a data file or in some other format. As used herein, a data file containing a patient's medical information may be referred to as "sensitive information." Other information, such as employment information, financial status, identification information, and many other types of information, may also be considered sensitive information.

[0095] A computing system may represent sensitive information through a coding algorithm (e.g., ASCII), a well-recognized file format (e.g., PDF), or some other format, where sensitive information can be protected from wide or easy disclosure by an encryption algorithm.

[0096] Generally speaking, sensitive information can be stored by a computing system as a discrete set of data bits. A set of data bits is sometimes referred to as "plaintext." Furthermore, a computing system can utilize an encryption process to convert the plaintext into a set of data bits having a highly unreadable state (i.e., ciphertext) using an encryption algorithm (i.e., a cipher). A computing system with knowledge of the encryption key used to create the ciphertext can restore this information to its plaintext, readable state. Thus, in some cases, sensitive data (e.g., sensor data 806a, 806b) is optionally encrypted before being communicated to a computing device.

[0097] In one embodiment, the operation of the information and communications technology (ICT) system 800 of Figure 10 includes one or more sensor data computer programs stored on a computer-readable medium. The computer programs can optionally derive and / or receive data from one or more stent sensors implanted in one or more patients. The sensor data computer programs can be executed in the computing server 802. Alternatively or additionally, the sensor data computer programs can be executed in the control unit 26, the interrogation unit 24.

[0098] In one embodiment, a computer program directing the collection and use of stent sensor data is stored on a non-transitory computer-readable medium in storage module 814. The computer program is configured to identify a patient having a wireless stent inserted therein. The wireless stent may include one or more wireless sensors.

[0099] In some cases, the computer program identifies one patient, and in other cases, two or more patients are identified, each having one or more wireless stents, each having one or more wireless sensors of the type described herein.

[0100] A computer program is configured to command the collection of sensor data from the wireless stent device. The sensor data is typically collected by wireless interrogation unit 24. In some cases, the program communicates with wireless interrogation unit 24. In other cases, the program communicates with control unit 26, which issues commands to wireless interrogation unit 24. In still other cases, other mechanisms for commanding the collection of sensor data are used.

[0101] Once the sensor data is collected, it may be further processed. For example, in some cases, the sensor data may include sensitive patient data that may be deleted or disassociated from such data. The sensor data may be stored individually (e.g., by unique sensor identification number, device number, etc.) or may be aggregated with other sensor data by sensor type, timestamp, location stamp, date stamp, patient type, other patient characteristics, or some other means.

[0102] The following pseudo-code description is used to generally describe one example algorithm executed by computing server 802 and generally described herein with reference to FIG. 10. TIFF0007815325000001.tif78150

[0103] Those skilled in the art will recognize that it is common practice in the art to embody devices and / or processes and / or systems and then incorporate such embodying devices and / or processes and / or systems into more comprehensive devices and / or processes and / or systems using techniques and / or other practices, i.e., at least portions of the devices and / or processes and / or systems described herein can be incorporated into other devices and / or processes and / or systems with a reasonable amount of experimentation. As will be recognized by those skilled in the art, examples of such other devices and / or processes and / or systems may include, as appropriate for the context and application, all or part of: (a) air vehicles (e.g., airplanes, rockets, helicopters); (b) ground vehicles (e.g., automobiles, trucks, locomotives, tanks, armored personnel carriers); (c) buildings (e.g., homes, warehouses, offices); (d) appliances (e.g., coffee makers, refrigerators, washers, dryers); (e) communications systems (e.g., networked systems, telephone systems, Voice over IP systems); (f) businesses (e.g., Internet Service Provider (ISP) businesses, e.g., Comcast Cable, Qwest, Southwestern Bell); or (g) wired / wireless service entities (e.g., AT&T, T-Mobile, Verizon).

[0104] In certain cases, use of a system or method may occur within a jurisdiction even if components are located outside the jurisdiction. For example, in a distributed computing context, use of a distributed computing system may occur within a jurisdiction even if portions of the system (e.g., relays, servers, processors, signal-bearing media, sending computers, receiving computers, etc., located outside the jurisdiction) are located outside the jurisdiction. In one embodiment of the present invention, a patient having a stent placed may be located in one location, while data processing and analysis occurs in another location.

[0105] Similarly, the sale of a system or method may occur in a jurisdiction even if components of the system or method are located and / or used outside the jurisdiction. Furthermore, the instantiation of at least a portion of a system that performs a method in one jurisdiction does not preclude use of the system in another jurisdiction.

[0106] In conclusion, various sensor-based stents are available to serve a variety of important clinical functions, such as safe, accurate, and minimally traumatic placement and deployment of the stent; procedural and postoperative "real-time" imaging of the stent and surrounding anatomical structures; the occurrence of stent complications; and the patient's overall health (cardiac, renal, and other physiological parameters). Currently, postoperative evaluation (both inpatient and outpatient) of stented patients relies on medical monitoring (vital signs, blood studies, ECG, etc.) supplemented with patient history, anthropometry, and diagnostic imaging studies as needed. However, much of the patient's recovery period occurs between hospital and clinic visits, and much of the data regarding daily functioning is uncaptured. Furthermore, monitoring the patient's progress using any diagnostic imaging technology can be expensive and invasive, and may carry its own health risks (e.g., coronary angiography). Therefore, accurately measuring and following the occurrence or worsening of symptoms and assessing stent performance in "real life" situations can be extremely challenging. This is especially true because symptoms are related to the patient's activity level, exercise tolerance, and the effectiveness of rehabilitation efforts and medications.

[0107] Currently, neither physicians nor patients have access to the type of "real-time," continuous, objective measurement of stent performance that they might otherwise desire. The ability to monitor stent function, health, anatomy, and physiological characteristics in situ can provide useful objective information to physicians during office visits, and patients can obtain additional readings at home at various times (e.g., when experiencing pain, during exercise, after taking medication, etc.) to provide important complementary clinical information to the physician (which can be transmitted electronically to a healthcare provider, even remotely). From a patient's perspective, the ability to monitor many of these same parameters at home can allow them to play a more preventative role in the patient's care and recovery and can provide the patient with either an early warning indicator or a warrant to seek medical assistance.

[0108] In one variation, the patient may also have such a reading device at home, which periodically collates data from the stent, e.g., daily or weekly. In addition to empowering patients to pursue their own rehabilitation—and allowing them to recognize the positive (and negative) effects of various lifestyle choices on their health and rehabilitation—such information access can be expected to improve compliance and patient outcomes. For example, in certain embodiments, the devices and systems provided herein can inform or otherwise notify the patient or an authorized third party of deviations (e.g., greater than 10%, 20%, 25%, 50%, 70%, and / or 100%) from normal and / or set parameters. Furthermore, a patient's recovery experience can be shared with other patients via the web, thereby comparing their progress with expected "norms" for function and rehabilitation and alerting the patient to signs and symptoms that should be brought to the patient's physician's attention (e.g., on Facebook or other social media sites). From a public health perspective, the performance of different stents can be compared in different patients (different genders, disease severities, activity levels, and comorbidities such as hypertension, diabetes, smoking status, obesity, etc.), thereby helping manufacturers design better stents and assisting physicians in selecting the appropriate stent for a particular patient type. Payers, patients, manufacturers, and physicians can all benefit from the collection of this comparative information. Adulterated or unsafe products can be identified and removed from the market, and objective, long-term valid data can be collected and analyzed. Finally, data collected at home can be collected and transmitted via the Internet to physician offices for analysis—potentially eliminating unnecessary visits and facilitating prompt medical follow-up.

[0109] Below are some specific numbered embodiments of the systems and methods disclosed herein. These embodiments are exemplary only. It is understood that the present invention is not limited to the embodiments set forth herein for purposes of illustration, but includes all such forms of the invention that fall within the scope of the above disclosure. [Embodiment 1] An assembly comprising a stent and a sensor disposed on or within the stent. [Embodiment 2] 2. The assembly of embodiment 1, wherein the sensor is disposed on an outer wall of the stent. [Embodiment 3] 2. The assembly of embodiment 1, wherein the sensor is disposed on an inner wall of the stent. [Embodiment 4] 2. The assembly of embodiment 1, wherein the sensor is disposed within the stent. [Embodiment 5] 2. The assembly of embodiment 1, wherein the sensor is positioned on a luminal surface, a paraluminal surface, and / or is implanted intraluminally. [Embodiment 6] The assembly according to any one of the first to fourth embodiments, wherein the sensor is a fluid pressure sensor. [Embodiment 7] The assembly according to any one of the first to fourth embodiments, wherein the sensor is a contact sensor. [Embodiment 8] The assembly according to any one of the first to fourth embodiments, wherein the sensor is a position sensor. [Embodiment Item 9] The assembly according to any one of the first to fourth embodiments, wherein the sensor is a pulse pressure sensor. [Embodiment 10] The assembly according to any one of the first to fourth embodiments, wherein the sensor is a blood content sensor. [Embodiment 11] The assembly according to any one of the first to fourth embodiments, wherein the sensor is a blood flow sensor. [Embodiment 12] The assembly according to any one of the first to fourth embodiments, wherein the sensor is a blood chemistry sensor. [Embodiment 13] The assembly according to any one of the first to fourth embodiments, wherein the sensor is a blood metabolism sensor. [Embodiment 14] The assembly according to any one of the first to fourth embodiments, wherein the sensor is a mechanical stress sensor, an accelerometer, or a temperature sensor. [Embodiment 15] 15. The assembly according to any one of embodiments 1 to 14, wherein the stent is a vascular stent, a gastrointestinal stent, a pulmonary stent, a head and neck stent, or a genitourinary stent. [Embodiment 16] 16. The assembly according to embodiment 15, wherein the vascular stent is a coronary artery stent, a carotid artery stent, a cerebral stent, a vertebral stent, an iliac stent, a femoral stent, a popliteal stent, or a stent for the arteries of the lower limbs. [Embodiment 17] 16. The assembly of embodiment 15, wherein said gastrointestinal stent is an esophageal stent, a duodenal stent, a colonic stent, a gallbladder stent or a pancreatic stent. [Embodiment 18] 16. The assembly of embodiment 15, wherein said pulmonary stent is a stent for holding open the trachea, bronchi, bronchioles or alveoli. [Embodiment 19] 16. The assembly of embodiment 15, wherein said genitourinary stent is a ureteral stent, a urethral stent, a prostatic urethral stent, or a fallopian tube stent. [Embodiment 20] 16. The assembly of embodiment 15, wherein the head and neck stent is a sinus stent, a maxillary sinus stent, a frontal sinus stent, a lacrimal stent, a nasal stent, or a tympanostomy tube. [Embodiment 21] The assembly according to any one of the first to twenty embodiments, wherein the stent is a biodegradable or partially biodegradable stent. [Embodiment 22] The assembly according to any one of embodiments 1 to 20, wherein the stent is a non-biodegradable stent. [Embodiment 23] The assembly according to any one of embodiments 1 to 22, wherein the sensor is a wireless sensor. [Embodiment 24] The assembly according to any one of the preceding embodiments, wherein the sensor is connected to a wireless microprocessor. [Embodiment 25] The assembly according to any one of the preceding embodiments, wherein a plurality of sensors are disposed on or within the stent. [Embodiment 26] The assembly of any one of paragraphs 1 to 25, wherein the stent has two or more types of sensors. [Embodiment 27] 27. The assembly of any one of embodiments 1-26, wherein the stent comprises one or more fluid pressure sensors, contact sensors, accelerometers, and position sensors. [Embodiment 28] 28. The assembly of any one of embodiments 1 to 27, wherein the sensors are a plurality of sensors disposed on or within the stent at a density of 1 or more, 2 or more, 3 or more, 4 or more, 5 or more, 6 or more, 7 or more, 8 or more, 9 or more, 10 or more, or 20 or more sensors per square centimeter. [Embodiment 29] 28. The assembly of any one of embodiments 1 to 27, wherein the sensors are a plurality of sensors disposed on or within the stent at a density of 1 or more, 2 or more, 3 or more, 4 or more, 5 or more, 6 or more, 7 or more, 8 or more, 9 or more, 10 or more, or 20 or more sensors per cubic centimeter. [Embodiment 30] 30. The assembly of any one of embodiments 1 to 29, wherein the sensor has a unique sensor identification number. [Embodiment 31] The assembly of any one of embodiments 1 to 30, wherein the sensor is uniquely defined within a designated location on or within the stent. [Embodiment 32] The assembly of any one of the preceding embodiments, wherein the stent is comprised of two or more sections. [Embodiment 33] 33. The assembly of embodiment 32, wherein the sensor is disposed on each of the two or more sections. [Embodiment 34] 33. The assembly of embodiment 32, wherein the sensor can be used to detect proper connection or assembly of the complete stent. [Embodiment 35] An assembly comprising a stent and a sensor, the sensor measuring cardiac output of a patient. [Embodiment 36] An assembly comprising a stent and a sensor, the sensor measuring the stroke volume of a patient. [Embodiment 37] An assembly comprising a stent and a sensor, the sensor measuring an ejection fraction of a patient. [Embodiment 38] An assembly comprising a stent and a sensor, the sensor measuring a patient's systolic blood pressure. [Embodiment 39] An assembly comprising a stent and a sensor, the sensor measuring a patient's diastolic blood pressure. [Embodiment 40] An assembly comprising a stent and a sensor, the sensor measuring a patient's mean arterial pressure. [Embodiment 41] An assembly comprising a stent and a sensor, the sensor measuring systemic vascular resistance of a patient. [Embodiment 42] An assembly comprising a stent and a sensor, the sensor measuring a patient's total peripheral resistance. [Embodiment 43] An assembly comprising a stent and a sensor, the sensor measuring a patient's temperature. [Embodiment 44] An assembly comprising a stent and a sensor, said sensor measuring the occurrence of restenosis. [Embodiment 45] An assembly comprising a stent and a sensor, the sensor measuring cardiac function. [Embodiment 46] An assembly comprising a stent and a sensor, said sensor measuring the occurrence of a thrombus, atherosclerosis, tumor, inflammation, abscess or other space-occupying lesion. [Embodiment 47] An assembly comprising a stent and a sensor, said sensor measuring the development of normal healing tissue on the luminal surface of said stent.

[0110] [Embodiment 48] An assembly comprising a stent and a sensor, the sensor measuring metabolic function including an indicator of renal function. [Embodiment 49] An assembly comprising a stent and a sensor, the sensor measuring cardiac rhythm including conduction and rhythm. [Embodiment 50] 50. The assembly according to any one of embodiments 1 to 49, wherein the stent is a drug-eluting stent. [Embodiment 51] The assembly of any one of paragraphs 1-50, wherein the stent is at least partially coated with one or more polymers. [Embodiment 52] Use of a stent or assembly according to any one of embodiments 1 to 51 for obtaining measurements of cardiac function. [Embodiment 53] 53. The use according to embodiment 52, wherein said measures of cardiac function are selected from the group consisting of cardiac output, stroke volume, ejection fraction, systolic and / or diastolic blood pressure, mean arterial pressure, systemic vascular resistance, and total peripheral resistance. [Embodiment 54] 54. The use according to embodiment 52 or 53, wherein said measurements are performed at two or more time points. [Embodiment 55] 55. The use according to any one of embodiments 52 to 54, wherein the measurements are carried out over 1 day or more, 2 days or more, 3 days or more, 4 days or more, 5 days or more, 10 days or more, 15 days or more, or 30 days or more. [Embodiment 56] 56. The use according to any one of embodiments 52 to 55, wherein the measurements are carried out over a period of 1 month or more, 2 months or more, 3 months or more, 4 months or more, 5 months or more, 6 months or more, or 12 months or more. [Embodiment 57] 1. A method for monitoring a stent, comprising: transmitting a wireless electrical signal from a location external to the human body to a location internal to the human body; receiving the signal at a sensor disposed on a stent disposed internal to the human body; powering the sensor using the received signal; detecting data at the sensor; and outputting the detected data from the sensor to a receiving unit located outside the human body. [Embodiment 58] The method according to paragraph 57, wherein said stent is an assembly according to any one of paragraphs 1 to 51. [Embodiment 59] 59. The method of any one of embodiments 57-58, wherein the receiving unit is a watch, a wristband, a mobile phone, or a pair of glasses. [Embodiment 60] 60. The method of any one of embodiments 57 to 59, wherein the receiving unit is located in the patient's residence or clinic. [Embodiment 61] 61. The method of any one of embodiments 57-60, wherein the detected data is provided to a healthcare provider. [Embodiment 62] 62. The method of any one of embodiments 57 to 61, wherein the detected data is posted to one or more websites. [Embodiment 63] 1. A non-transitory computer-readable storage medium having stored contents for configuring a computing system to perform a method, the method comprising: identifying a patient, the identified patient having at least one wireless stent, each wireless stent having one or more wireless sensors; directing a wireless interrogation unit to collect sensor data from at least one of said respective one or more wireless sensors; A non-transitory computer-readable storage medium comprising receiving the collected sensor data. [Embodiment 64] 1. A non-transitory computer-readable storage medium having stored contents for configuring a computing system to perform a method, the method comprising: further comprising identifying a plurality of patients, each identified patient having at least one wireless stent, each wireless stent having one or more wireless sensors; directing a wireless interrogation unit associated with each identified patient to collect sensor data from at least one of said respective one or more wireless sensors; receiving the collected sensor data; 64. The non-transitory computer-readable storage medium of claim 63, further comprising aggregating said collected sensor data. [Embodiment 65] The above method is removing sensitive patient data from the collected sensor data; 64. The non-transitory computer-readable storage medium of embodiment 63, wherein the stored contents configure a computing system to perform the method, further comprising the step of: parsing the collected data according to a sensor type. [Embodiment 66] A non-transitory computer-readable storage medium as described in embodiment 63, wherein the stored contents configure a computer computing system to perform a method, wherein the step of instructing the wireless interrogation unit includes the step of instructing a control unit associated with the wireless interrogation unit. [Embodiment 67] The non-transitory computer readable storage medium according to any one of embodiments 63 to 66, wherein the stent is an assembly according to any one of embodiments 1 to 51. [Embodiment 68] A non-transitory computer-readable storage medium according to any one of embodiments 63 to 67, wherein the collected sensor data is received on a watch, a wristband, a mobile phone, or glasses. [Embodiment 69] A non-transitory computer-readable storage medium according to any one of embodiments 63 to 68, wherein the collected sensor data is received at the patient's residence or office. [Embodiment 70] 70. The non-transitory computer-readable storage medium of any one of embodiments 63 to 69, wherein the collected sensor data is provided to a healthcare provider. [Embodiment 71] The non-transitory computer-readable storage medium of any one of embodiments 63 to 70, wherein the collected sensor data is written to one or more websites. [Embodiment 72] The method according to any one of the embodiments 57 to 62 or the storage medium according to any one of the embodiments 63 to 71, wherein the data is analyzed. [Embodiment 73] 73. The method or storage medium of embodiment 72, wherein the data is plotted to allow visualization of changes over time. [Embodiment 74] 74. The method or storage medium of claim 72 or 73, wherein the data is plotted to provide a three-dimensional image. [Embodiment 75] A method for determining deterioration of a stent, comprising the steps of: a) providing an assembly including a stent and one or more sensors to a body passage of a patient; and b) detecting changes in the sensors, thereby determining deterioration of the stent. [Embodiment 76] The method of embodiment 75, wherein the sensor is capable of detecting one or more physiological and / or location parameters. [Embodiment Item 77] 77. The method of any one of embodiments 75 to 76, wherein the sensor detects contact, fluid flow, pressure, and / or temperature. [Embodiment 78] 78. The method of any one of embodiments 75 to 77, wherein the sensor detects a location inside the patient's body. [Embodiment 79] The method according to any one of embodiments 75 to 78, wherein the assembly is the assembly according to any one of embodiments 1 to 51. [Embodiment 80] 80. The method according to any one of embodiments 75 to 79, wherein said detecting step is a series of detections over time. [Embodiment 81] 1. A method of imaging a stent, comprising detecting changes over time in sensors in, on, and / or within the stent, wherein the stent has sensors at a density of 1 or more, 2 or more, 3 or more, 4 or more, 5 or more, 6 or more, 7 or more, 8 or more, 9 or more, 10 or more, or 20 or more sensors per square centimeter. [Embodiment 82] 1. A method of imaging a stent, comprising detecting changes over time in sensors in, on, and / or within the stent, wherein the stent has sensors at a density of 1 or more, 2 or more, 3 or more, 4 or more, 5 or more, 6 or more, 7 or more, 8 or more, 9 or more, 10 or more, or 20 or more sensors per cubic centimeter. [Embodiment 83] The method of embodiment 81 or 82, wherein the sensor is one or more of a fluid pressure sensor, a contact sensor, a position sensor, an accelerometer, a pulse pressure sensor, a blood volume sensor, a blood flow sensor, a blood chemistry sensor, a blood metabolism sensor, a mechanical stress sensor, and a temperature sensor. [Embodiment 84] The method according to any one of embodiments 81 to 83, wherein the stent is an assembly according to any one of embodiments 1 to 51. [Embodiment Item 85] A method for placing a stent in a patient's body, comprising: a) implanting an assembly according to any one of embodiments 1 to 51; and b) detecting the placement of the stent by detecting a sensor. [Embodiment 86] The method of embodiment 85, wherein the stent has two or more segments, and detection of the two or more segments can be determined by analysis of one or more sensors. [Embodiment 87] The method of any one of embodiments 85 and 86, wherein the placement of the stent can be visualized by a two-dimensional or three-dimensional display or image of the one or more sensors on the stent. [Embodiment Item 88] The method according to any one of embodiments 85 to 87, wherein the stent comprises two stents implanted so as to overlap each other. [Embodiment 89] 89. The method of any one of embodiments 85-88, wherein said detection of said stent placement allows for determination of whether said stent is kinked or incorrectly placed.

[0111] Any of the various embodiments described above may be combined to provide additional embodiments. All U.S. patents, U.S. patent application publications, U.S. patent applications, PCT application publications, foreign patents, foreign patent applications, and non-patent literature referenced herein are incorporated by reference in their entireties. Aspects of the embodiments may be modified, if necessary, to employ concepts from various patents, patent applications, and patent application publications to provide further embodiments. These and other modifications can be made to the embodiments in light of the above detailed description. In general, in the following claims, the terms used should not be construed to limit the claimed invention to the specific embodiments disclosed in the specification and claims, but should be construed to include all possible embodiments, along with the full scope of equivalents to which the claims are entitled. Therefore, the claimed invention is not limited by the disclosure of the specification.

Claims

1. 1. An assembly comprising: a first stent portion and a second stent portion; an accelerometer is disposed in each of the first stent portion and the second stent portion, and a mechanical stress sensor is disposed in at least one of the first stent portion and the second stent portion; an assembly, wherein the first stent portion and the second stent portion are combined to provide a stent, and the accelerometer is configured to detect proper connection or assembly of the first stent portion and the second stent portion.

2. The assembly of claim 1 , wherein the mechanical stress sensor is disposed on an outer wall of the stent or on an inner wall of the stent.

3. The assembly of claim 1 , wherein the mechanical stress sensor is disposed within the stent.

4. The assembly of claim 1 , wherein the mechanical stress sensor is disposed on a luminal surface, a paraluminal surface, and / or is implanted intraluminally.

5. 10. The assembly of claim 1, wherein the stent is a vascular stent, a gastrointestinal stent, a pulmonary stent, a head and neck stent, or a genitourinary stent.

6. The assembly of claim 1 , wherein the stent is a biodegradable or partially biodegradable stent.

7. The assembly of claim 1 , wherein the stent is a non-biodegradable stent.

8. The assembly of claim 1 , wherein the mechanical stress sensor is a wireless sensor.

9. The assembly of claim 1 , wherein the mechanical stress sensor is connected to a wireless microprocessor.

10. The assembly of claim 1 , wherein the accelerometer has a unique sensor identification number.

11. The assembly of claim 1 , wherein the accelerometer is uniquely defined within a designated location on or within the stent.

12. The assembly of claim 1 , wherein the stent is at least partially coated with one or more polymers.

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